Ultrasound of the Pleurae and Lungs Dietrich, Christoph F.; Mathis, Gebhard; Cui, Xin-Wu ...
Ultrasound in medicine & biology,
02/2015, Letnik:
41, Številka:
2
Journal Article
Recenzirano
Odprti dostop
The value of ultrasound techniques in examination of the pleurae and lungs has been underestimated over recent decades. One explanation for this is the assumption that the ventilated lungs and the ...bones of the rib cage constitute impermeable obstacles to ultrasound. However, a variety of pathologies of the chest wall, pleurae and lungs result in altered tissue composition, providing substantially increased access and visibility for ultrasound examination. It is a great benefit that the pleurae and lungs can be non-invasively imaged repeatedly without discomfort or radiation exposure for the patient. Ultrasound is thus particularly valuable in follow-up of disease, differential diagnosis and detection of complications. Diagnostic and therapeutic interventions in patients with pathologic pleural and pulmonary findings can tolerably be performed under real-time ultrasound guidance. In this article, an updated overview is given presenting not only the benefits and indications, but also the limitations of pleural and pulmonary ultrasound.
•Development of a feasible imaging protocol in postmortem magnetic resonance imaging (PMMR) superior to postmortem computed tomography (PMCT).•Possibility to distinguish between postmortem clotting ...and pulmonary thromboembolism in postmortem magnetic resonance imaging.•PMMR allows an age graduation of the pulmonary thromboembolism according to histological grading.
The purpose of this study was to develop a feasible imaging protocol superior to postmortem computed tomography (PMCT) and to establish diagnostic parameters for diagnosing pulmonary thromboembolism (PE) on postmortem magnetic resonance imaging (PMMR).
The study collective of 113 subjects was prospectively investigated by PMMR for the presence of PE and / or postmortem clotting (cruor). PE was detected in 20 cases; the remaining 93 cases were investigated for the morphology of cruor. Age grading was performed by PMMR, autopsy and histology. The postmortem sedimentation effect was used for the applied imaging protocol on PMMR (supine and prone position). Visual distension of the pulmonary arteries in PE was seen in all cases, but not in the controls. Re-positioning of the corpse from supine in prone position proved to be beneficial in 90 %. Postmortem motion artifacts are firstly described in 20.4 %. Hyperacute PE (grade 1) presented with a homogenous and hypointense signal on T2w images, acute PE (grade 2) with slightly heterogeneous, but still homogenous hypointense signal, subacute PE (grade 3) was with heterogeneous and slightly hyperintense signal and chronic PE (grade 4) with predominately homogenous with scarce portions of heterogeneous but hyperintense signal. PMMR allowed for the detection of PE and for in situ depiction of combined age grading.
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Objectives
To investigate unenhanced postmortem 3-T MR imaging (pmMRI) for the detection of pulmonary thrombembolism (PTE) as cause of death.
Methods
In eight forensic cases dying from a possible ...cardiac cause but with homogeneous myocardium at cardiac pmMRI, additional T2w imaging of the pulmonary artery was performed before forensic autopsy. Imaging was carried out on a 3-T MR system in the axial and main pulmonary artery adapted oblique orientation in situ. In three cases axial T2w pmMRI of the lower legs was added. Validation of imaging findings was performed during forensic autopsy.
Results
All eight cases showed homogeneous material of intermediate signal intensity within the main pulmonary artery and/or pulmonary artery branches. Autopsy confirmed the MR findings as pulmonary artery thrombembolism. At lower leg imaging unilateral dilated veins and subcutaneous oedema with or without homogeneous material of intermediate signal intensity within the popliteal vein were found.
Conclusions
Unenhanced pmMRI demonstrates pulmonary thrombembolism in situ. PmMR may serve as an alternative to clinical autopsy, especially when consent cannot be obtained.
Key Points
• Postmortem MRI (pmMRI) provides an alternative to clinical autopsy
• Fatal pulmonary thrombembolism (PTE) can now be diagnosed using postmortem MRI (pmMRI).
• Special attention has to be drawn to the differentiation of postmortem clots.
There has been recent interest in the radiological literature regarding the various clinical manifestations of epiploic appendagitis, which may mimic many acute abdominal and pelvic conditions. We ...present a case of appendagitis masquerading as pulmonary embolism; to our knowledge the first reported such presentation with primary thoracic symptoms and findings prompting an initial workup for suspected pulmonary thrombembolism. Radiographic findings, differential diagnosis and the pertinent literature are briefly discussed.
A 68-year-old non-diabetic physician with a known psychiatric history was found dead in his home. The death scene investigation revealed three used insulin syringes on the coffee table next to the ...body. The autopsy and the consecutive chemical–toxicological investigation revealed that the deceased committed suicide by injecting an overdose of insulin in combination with a high therapeutic oral bolus application of a β-blocker (Metoprolol). A surprising morphological finding was a terminal pulmonary thrombembolism in the right pulmonary artery.
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